Drug treatments for obstructive sleep apnoea

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Abstract
Background The treatment of choice for moderate to severe obstructive sleep apnoea (OSA) is continuous positive airway pressure (CPAP) via a mask during sleep. However this is not tolerated by all patients and its role in mild OSA is not proven. Drug therapy has been proposed as an alternative to CPAP in some patients with mild to moderate sleep apnoea. The mechanisms by which drugs might reduce OSA include: a reduction in the proportion of rapid eye movement (REM) sleep (during which apnoeas tend to be more frequent), an increase in ventilatory drive or an increase in upper airway muscle tone during sleep. Objectives To determine the efficacy of drug therapies in the treatment of sleep apnoea. Search methods We carried out searches on the Cochrane Airways Group trials register. We also performed additional handsearching as relevant. Searches were current as of February 2000. Selection criteria Double blind, randomised placebo controlled trials, involving patients with confirmed obstructive sleep apnoea. We excluded trials if continuous positive airways pressure, mandibular devices or oxygen therapy were used. No restriction was placed upon publication language or trial duration. Data collection and analysis A total of 51 references were identified by electronic searches. Two reviewers independently assessed studies for inclusion, undertook data extraction according to pre‐specified entry criteria, and quality assessment of studies. No response for further information was forthcoming from study authors. Results were expressed as (WMD) and 95% Confidence Intervals (CI). Main results Nine trials involving 91 participants were included in the review. Studies were small and some trials had methodological limitations. Only acetazolamide reduced the apnoea hypopnoea index (AHI) (one crossover trial of nine patients, WMD ‐24 (95% CI ‐4 to ‐44). However there was no symptomatic response and the drug was poorly tolerated. Protriptyline led to a symptomatic improvement (improved versus not improved) in two out of three crossover trials (13 participants, Peto Odds Ratio 29.2 (95% CI 2.8 to 301.1) but there was no change in the apnoea frequency. No beneficial effects were found for medroxy progesterone, clonidine, buspirone, aminophylline, theophylline or sabeluzole. Authors' conclusions The data available do not support the use of drugs as a therapy for OSA. Although the studies examined had limitations there was little to justify further trials of these particular drugs.